Searching for the right balance between the highs and lows of diabetes

Choice Is Necessary.

United Healthcare has decided that, as of July 1, adult patients with diabetes on certain UHC insurance plans who want insulin pump therapy should only be allowed to choose a Medtronic insulin pump. Hat tip to DiabetesMine for breaking the news.

There’s a lot more to it than just that one sentence, and obviously, people have a lot of questions.

Let me first say this: people who work for medical device makers and insurance companies are actual people, and they have families and concerns of their own, so I don’t think it’s fair to equate companies and their practices with the people who work hard for them every day.

That said, it’s really hard to find anything good in this discovery. Let’s be honest, okay? There is nothing good in this discovery. It is only benefitting those implementing the rule, and only harming those affected by the rule.

There was some explanation from United Healthcare about why they’re going down this road, and it’s a ridiculously weak argument. You can come to your own conclusions about it after you read what they have to say about it. But my take is that they’re not even trying to give a good explanation for this. Medtronic, for their part, has remained silent.

Did UHC get something for making Medtronic an exclusive provider? Or are they just being lazy, deciding they don’t want to keep up on all of the insulin pump manufacturers out there? Is Medtronic out there trying to cut similar deals with other insurance companies? Does this put pressure on other device makers to try and secure their own piece of the pie? Most of all: What if an actual artificial pancreas solution is approved by the U.S. Food and Drug Administration, and it’s not a Medtronic solution? Does that leave UHC patients out in the cold?

I’m not even going to try to answer those questions. They’re not important. They just don’t matter.

Because any way you slice it, this is bad news for People With Diabetes.

United Health Group, parent company of United Healthcare, has this as their mission statement:

“We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities.”

“We work with health care professionals and other key partners to expand access to quality health care so people get the care they need at an affordable price.”

“We support the physician/patient relationship and empower people with the information, guidance, and tools they need to make personal health choices and decisions.”

It appears that the latest about this exclusivity arrangement shows UHC’s mission statement to be rather disingenuous. In fact, it looks like they just took a giant shit all over it and its claims to “expand access to quality health care so people get the care they need at an affordable price”.

Reducing Eliminating choice for patients is wrong, it reduces innovation, and in no way does it “improve the overall health and well-being” of People With Diabetes, or even save them money.

I’m going to start saying something, and I’m going to repeat it any time someone asks me why something like this is a big deal.

Choice isn’t just important… choice is necessary.

Companies love to talk about how competition is good for the marketplace, good for consumers. Apparently, it’s not good enough for United Healthcare, because they just turned a fire hose on the idea of competition. You know, there are studies that show People With Diabetes do better when they have more information, more tools, and yes, better tools to help them manage their condition. I can’t find a single shred of evidence anywhere that says removing choices for patients with a chronic condition helps them live better lives.

You are wrong, United Healthcare. You’ve made a decision that only benefits you, and does not ensure even one better outcome for any of your patients. You are wrong, and I will keep telling your rotten story to as many people as I can. Including my elected officials, and news agencies.

For my part, I wish I would have had access to this information when I visited Medtronic a couple of weeks ago. The upper echelons of Medtronic Diabetes management was there that day, and someone must have known that this decision was imminent. But they didn’t share it with any of the advocates in the room. I would have liked to have asked questions and share my view directly with Medtronic brass that day.

Just as there are actual people working for these two organizations, there are actual People With Diabetes insured by UHC. And those people deserve and are entitled to choices when it comes to how they manage their diabetes. Patient trumps proprietary. And it always will.

Wow, I agree with Lucia, this will greatly limit competition leading to better technologies! Wondering if insurance companies are doing this in other countries, and how is this even allowed?! Aren’t there rules against monopolies?

Wow, that mission-statement sure says a lot, doesn’t it? I think we need to repeat it over and over in our vocal demonstration of how UHC completely missed the mark on this one. The best way to win a battle is to use the opponent’s words against them — either they’ll come to a realization that they strayed too far from their guiding principles, or they’ll admit to a culture-change. The point of a mission statement is so that a company doesn’t lose sight of the big picture in the minutiae of their day-to-day activities, and this one beats repeating. And by the way, I looked at United Health Group’s stock price over the last two years, and it’s steadily increasing — so any potential defense about being backed into a corner, or forced to impose sacrifices due to the Affordable Care Act would be completely unfounded.

As for the people, that’s where I am the most conflicted. While I am angry at both corporations, I also have friends who as employed by both — and I don’t want to stress those relationships (nor do I want to exploit them). Yet, I have an obligation to stand up for what I believe is right.

I, too, feel betrayed by the organization that hosted me last month, and that betrayal hurts more than anything else. But there was one individual at that session who continued to lose my trust as the day went on (Stephen, you know exactly who I’m talking about) — and I suspect my gut was right. I’m sure this person’s fingerprints are all over this godforsaken agreement.

I think you’ve found an important issue, not only for diabetics, but for health care in general. Every time you hear politicians call for “free market reforms” in health care, you’ve got a perfect example for them to lay out specifics on how their proposals would affect the situation.

In this case, if a free market existed, you could tell UHC you disagree with their choice of insulin pumps and take your money to another insurance company. The current system makes that decision extremely difficult.

One, your insurance company is decided by your employer. Two, your employer is paying a significant amount of your health care, and you’d lose that subsidy if you went out on your own.

What UHC is doing with insulin pumps is what all insurance companies have done across health care: Find a supplier and negotiate as good a deal as possible to save money. Whether you’re on Humalog or Novolog is probably an insurance company decision. Whether your A1c is done by Labcorp or Quest, it’s an insurance company decision. Innovation, convenience, choice and all the other factors that go into consumer decisions are ignored.

A Disclaimer

I have no medical training. If you consider anything written here as medical, legal, financial, or any other kind of advice, you’re out of your mind. Please speak to a learned professional before making any changes that might affect your health. Any of the original content found on this site is my property and should not be reproduced, copied, or otherwise used without the author’s expressed written consent.